What Will The Blue Dogs Offer To Achieve The Savings Of A Robust Public Option?

nancy-pelosiThe Hill reports that “Pelosi made it clear in a leadership meeting Tuesday night that she intends for the Medicare-based public option to be included in the final House bill. But she acknowledged in a meeting of the full caucus later that she doesn’t yet have the 218 votes among Democrats that she needs to guarantee its passage.”

Over at The Treatment, Jonathan Cohn asks (and answers) ‘What is Nancy Pelosi Doing?.” It’s a good question, but reformers should also ask, ‘What is Nancy Pelosi Getting?’ Blue Dogs and some moderate lawmakers believe (wrongly, in my opinion) that a public option that reimburses at Medicare rates for the first 2 to 3 years would devastate rural providers (they’ll all go down in three years, you see).

But if Blue Dogs reject the public plan, then Pelosi must ask them to offer policy solutions that can meet the objectives of a robust public option:

– If you reject the public option, how will they make up for its estimated $100 billion in savings?

– The public option will lower premiums by about 10%, so how should we make coverage more affordable within the Exchange?

– How will you hold insurers’ feet to the fire to ensure that they don’t game the new rules and your constituents?

Reformers don’t have $100 billion to waste. They don’t have the extra dollars to increase affordability subsidies. In other words, they don’t have the luxury to dispose of a policy that can help make coverage more affordable.

If the Blue Dogs want to gut the plan, they must propose reforms that achieve the same objectives: a compromise public option that triggers market rates if they devastate providers, increase affordability subsidies, institute new regulatory and accountability entities to hold insurers accountable, expand Medicaid even further. The list is long, and Blue Dogs should start pitching some ideas. They shouldn’t get something for nothing.